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Facing Widespread Burnout, can Digital Health Bring Physicians Back to the Bedside?

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The slow-moving wave of physician burnout has been exacerbated over the last two
years by the COVID-19 pandemic, and the medical community has suffered its highest-ever
rates of provider burnout. In pre-pandemic times, 1 in 3 physicians reported being burnt out,
and 80% were at high or very high risk of burnout (1,2). With the pandemic in full swing, this
statistic rose to the point that every other physician was suffering from self-reported burnout,
associated with a 1% rate of attempted physician suicide and 13% rate of suicidal ideation (3).

Physician burnout is directly correlated with physician disengagement and physician
turnover, setting the scene for an unsafe and expensive healthcare system. Based on the
Jackson Physician Search Physician Retention Survey, 15% of physicians looking to change their
current employment intend to leave the practice of medicine altogether. The more recent
Elsevier Health study reported an alarming statistic that healthcare is at risk of losing 75% of the
workforce by 2025 if it remains unchanged. Characteristic features of burnout including
impaired memory and attention create a fertile basis for medical errors and patient safety
concerns. The reverberations of poor physician retention are expensive to healthcare systems-
from lost revenue related to staffing shortages to recruitment and onboarding costs in the
hiring process.

Now, two years deep into the COVID pandemic, the crisis of physician burnout has
boiled over. Critical staffing shortages across the country demand more of a workforce at the
end of its rope. However, can leveraging digital health solutions that simplify the work and
extend the reach of physicians become the most practical, attainable, and sustainable solution
at hand?

Answering this question requires most practicing physicians to recall the clunky
digitization of healthcare over the last 20 years. These “improvements” made providers
skeptical that digital solutions can lead us out of the inefficiencies that burden modern
healthcare today. In fact, close to 70% of physicians are already overwhelmed by the volume of
patient data and expect it to worsen with widespread consumerism of remote digital health
technologies (4). The onus is on the digital health community to design and build better
solutions that focus on the way physicians work and entice physicians back to the bedside.
Enhancing the work life of the healthcare provider is the 4th pillar of the quadruple aim, and is
as salient today as it was in 2014 when it was first described (5).

The top three pain points of highest priority to address include: 1) Electronic Health
Record (EHR) 2) Communication Streams and 3) Time Management. The current solutions are
no longer tenable. Here, we will focus on the reprioritization of the physician’s time and
effectiveness in these domains.

ELECTRONIC HEALTH RECORD:

The EHR was a well-intentioned effort to reduce handwritten medical errors while
optimizing medical billing. Since then, it has slowly but surely developed as a consequence of an
array of uncoordinated short-term solutions with no long-term vision at the hands of >500
vendors. Now, it is a heavy behemoth that physicians tackle daily and is touted as the single
biggest stressor on physician burnout. Failures include poor, non-intuitive usability, a slow
learning curve, high click burden, alert fatigue, lack of interoperability, and inaccessible
information (6).

A full overhaul of the EHR format and interface is long overdue. A redesigned EHR most
urgently needs:

– Fool-proof usability (as we have come to expect of smartphone iOS and Android
designs), foregoing the need for 4-8 hour in-person training sessions with a
superuser.
– Dynamic specialty-specific efficiency dashboards that adjust relevant information
based on the patient’s complaint or diagnosis. This goes hand-in-hand with
reporting integrated and analyzed data with associated prediction models of
patient-specific risk.
– Trim the fat of redundancy and clutter, specifically as it applies to the volume of
clicks and alerts.
– Organized, accurate and extractable big data storage that is used for real-time
feedback on metrics that hasten the pace of quality improvement and improve
insights into the causal sequence of disease.
– Seamless interoperability with shared data that will do away with the days of
mailed CDs and faxed records, reduce physician/nurse transcription time, and
reduce healthcare costs and testing.

COMMUNICATION STREAMS

We are in a unique time of multiple modalities of communication competing for a
physician’s attention without a triaging algorithm based on urgency. As such, physicians are
flooded daily by phone calls, text messages, emails, the EHR inbox, Microsoft teams, Slack
notifications, and a multitude of HIPAA compliant texting apps which create unrealistic
expectations of instantaneous response times. With acute care telehealth services on the rise,
this level of communication is multiplied by the numerous facilities covered simultaneously. In
parallel, communication regarding licensing/credentialing, scheduled deficiency reminders,
monthly password resets, and billing inquiries increases. As remote patient monitoring devices
become mainstream, this will be another layer of data management that will need time and
attention.

All this creates an enormous volume of chaotic communication to be sifted through
daily, extending beyond an individual’s capacity and creating a high likelihood of missed
communication. Furthermore, this communication is 24/7/365 and chips away at the
physician’s work-life balance, contributing to burnout.

Effective, reliable and timely means of physician communication is central to the
therapeutic doctor-patient relationship. Communication platforms need to be consolidated and
prioritized based on patient care needs. Associated factors including regulations,
reimbursement, liability, and privacy are beyond the scope of this article. As telehealth grows,
streamlining communication through the workday will extend the reach and capacity of
physicians, ultimately making them more productive and delivering better, less disrupted care.

TIME MANAGEMENT

Reducing time with patients during the workday and reducing time with family after
work increases burnout. Physicians spend 43% of their time documenting and 28% of their time
at the bedside – which means for every 2 minutes with a patient, a physician spends 3 minutes
at a computer converting that work into billable documentation (7). With a busy clinical
schedule, that documentation time bleeds into personal time in the evening and weekends,
commonly referred to as “pajama time.” This pajama time work is particularly vulnerable to
being overestimated upon recollection, and thus infringements on after-hours time contribute
more heavily to burnout (8).

Optimizing physician time utilization is key. EHR shortcuts and voice
recognition/dictation have been welcome first steps in the right direction to reduce
documentation time/burden. The potential for AI/ML to redesign this space is met with
cautious optimism. The opportunity to streamline clinical work with ambient documentation,
clinical decision support as well as data alert management is powerful. Although it has yet to
become mainstream and demonstrates its full potential, the elegance of AI/ML integration is
that it is not disruptive to the physician’s workflow and it reconnects the physician’s attention
back to the patient.

At the intersection of the highest levels of clinician burnout and critical staffing
shortages, the healthcare system is out to sea without a paddle. In addition to patient-oriented
care, there needs to be a shift to physician-friendly care that supports physicians staying in
healthcare in the first place. Physicians need purpose, balance, and streamlining of the work at
hand. Digital health is poised to be the solution to reduce the clutter and bring physicians back
to the bedside.

The scope of this piece relates specifically to physician burnout. However, we recognize the rates
of burnout in nurses, advanced practice providers, and others in the medical community is similarly overbearing and believe that the solutions we offer here will be beneficial to the
medical community as a whole.

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